Book

Psychological Injuries: Forensic Assessment, Treatment, and Law

Authors:

Abstract

Human emotional suffering has been studied for centuries, but the significance of psychological injuries within legal contexts has only recently been recognized. As the public becomes increasingly aware of the ways in which mental health affects physical—and financial—well-being, psychological injuries comprise a rapidly growing set of personal injury insurance claims. Although the problems that people claim to suffer from are serious and often genuine, the largely subjective and unobservable nature of psychological conditions has led to much skepticism about the authenticity of psychological injury claims. Improved assessment methods and research on the economic and physical health consequences of psychological distress has resulted in exponential growth in the litigation related to such conditions. Integrating the history of psychological injuries both from legal and mental health perspectives, this book offers discussions of relevant statutory and case law. Focusing especially on post-traumatic stress disorder, it addresses the current status and empirical limitations of forensic assessments of psychological injuries and alerts to common vulnerabilities in expert evidence from mental health professionals. In addition, it also uses empirical research to provide the best forensic methods for assessing both clinical conditions such as post-traumatic stress disorder and for alternative explanations such as malingering.
... The chapter will not focus on legal issues per se or provide extensive legal background for certain topics. Readers wanting more extensive details on legal matters related to psycholegal assessment may consider the following excellent references: Heilbrun (2001) , Van Dorsten (2002) , Schultz and Brady (2003), Koch et al. (2006 . This chapter cannot be exhaustive in covering the psycholegal aspects of all potential repercussions of MVCs. ...
... In contrast, a person responding affi rmatively to the presence of every symptom in a particular diagnostic category does not mean a psychological or psychiatric condition is present either. In sum, the use of a semi-structured interview helps to reduce diagnostic variability by reducing idiosyncratic questions , inconsistent coverage of problem areas, different sequencing of questions, and variability in rating the severity and frequency of diagnostic symptoms of interest ( Koch et al., 2006 ). The psycholegal assessment also needs to provide a statement on an individual ' s coping style. ...
... Generally, the more clinical judgments are based on actuarial data or statistical prediction, the more accurate the judgments are likely to be ( Grove et al., 2000 ; Faust, 2003 ). The strength of any psycholegal assessment can only be enhanced by assessors recognizing common errors in clinical judgment ( Faust 2003 ; Koch et al., 2006 ). Examples of errors in clinical judgment include biased heuristic decision rules, underuse of base rates, confi rmatory bias, illusory correlation, and failure to recognize regression toward the mean. ...
Article
Full-text available
This chapter presents and discusses the issues involved with motor vehicle collisions in a psycholegal context and conducting a psycholegal assessment. The assessment is designed to assess the changes in physical status, quality of life, and psychological functioning. Issues related to psychological impairment and disability, causality, coping, psychiatric diagnosis, malingering and litigation stress, and prognosis are addressed. Although injuries can occur to persons involved in both vehicles, one driver and, ultimately, the insurance company covering that person may incur liability for the collision. The injured person can then sue the liable insurance company for permanent income loss, pain and suffering, and other losses. There are a number of reasons that an injured or traumatized person can be referred to a psychologist, psychiatrist, or other mental health professional. Great emphasis is placed on providing clinical examples related to pain conditions rather than neuropsychological presentations or posttraumatic stress disorder.
... The individual's degree of preexisting psychological difficulties, in terms of either latent predisposition or symptomatic expression, presents a baseline in establishing whether a meaningful alteration of mental-emotional tranquility had been induced. Koch et al. (2006) indicated that for thresholds to be met, the claimed psychological injury must be harmful or serious enough. In some jurisdictions, examples serve to define serious psychological injury, for example, the individual has developed a phobia. ...
... [See the discussion of malingering in Nicholson and Martelli's, Section III, and Kane's chapters, Section II, in this book. The chapter by Iverson and Lange (2006) in Koch et al. (2006) is another useful source.] ...
... The informed assessor will proceed cautiously at all these levels in determining disability. Koch et al. (2006) note that the assessor must logically demonstrate or trace a causal link or pathway between a deficit and the focus of the case, whether occupational, educational, social, or recreational functioning. Dillman (2003) suggested that in cases of personal injury, occupational functioning might be affected in the domains of memory, concentration, social interaction, and adaptation to change (as summarized by Koch et al., 2006). ...
Chapter
The study of causality and related terms has its roots in philosophy, and the concept is considered important in many contemporary fields of research. Despite its pervasiveness, there is little agreement in psychology and law about causality's definition, underlying conceptual basis, and implications for legal actions in which psychology is at issue. A comprehensive account of causality and related terms, which can help both fields navigate the difficulties that these concepts present, is direly needed, and this book has been written to fill this void. In the first section of this chapter, we address the area of legal issues and causality, such as evidence law, torts, and how causality is treated in law. Then, in the second section, we turn to more psychological considerations, such as forensic mental health assessment (FMHA), disability, and catastrophic impairment. At the end of the chapter, we present in an appendix the concepts of reliability and validity in psychological assessment.
... In cases where symptoms persist beyond 4 weeks, the diagnosis is changed to PTSD. The obvious similarity between these two conditions, coupled with the inclusion of a seemingly arbitrary 4-week timeline for ASD, has exposed the DSM to considerable criticism for arbitrarily dividing what appears to be a single disorder (Koch, Douglas, Nicholls, & O'Neill, 2006). Given that the distinction between these two conditions is not widely recognized in the literature (Koch et al., 2006), the acute form of the condition (ASD) is subsumed under the general heading of PTSD for the purposes of this review. ...
... The obvious similarity between these two conditions, coupled with the inclusion of a seemingly arbitrary 4-week timeline for ASD, has exposed the DSM to considerable criticism for arbitrarily dividing what appears to be a single disorder (Koch, Douglas, Nicholls, & O'Neill, 2006). Given that the distinction between these two conditions is not widely recognized in the literature (Koch et al., 2006), the acute form of the condition (ASD) is subsumed under the general heading of PTSD for the purposes of this review. These diagnostic concerns notwithstanding, the existence of pathological stress reactions has been widely accepted for decades. ...
... Research continues to accumulate regarding contributing factors, symptom course, and treatment options. In a recent review of the literature, for example, Koch et al. (2006) reported that 15% to 39% of victims of crime tend to develop PTSD, with exposure to sexual violence being an especially powerful risk factor for the development of trauma reactions. A range of other criminal and noncriminal variables (e.g., natural disasters, motor vehicle accidents ) have also been empirically linked to PTSD, and both anger and shame have been identified as strong mediating variables in the development of this disorder (Koch et al., 2006 ). ...
Article
Full-text available
Recent work has documented the relatively high incidence of Posttraumatic Stress Disorder (PTSD) symptoms in women during the birth delivery process and afterwards, even in uncomplicated births. This phenomenon, however, has yet to be linked with cases of neonaticide (child homicide in the first 24 hr of life) or infanticide (child homicide within the 1st year of life). Women are more likely to experience mental disorder after childbirth than at any other time in their lives, and the intentional killing of an offspring by a mentally ill mother is likely underreported. The immediate postpartum period is a time of heightened vigilance by health providers and, when the tragic death of an infant occurs, forensic professionals should specifically assess for PTSD. As an illustration, the authors present a case of maternal neonaticide that was directly linked to PTSD without any other concomitant mental disorder. PTSD is a viable mitigating factor to be examined in legal defenses of infanticide either in isolation or in conjunction with other factors.
... Certain characteristics of CSA experiences are associated with increased risk for later psychological difficulties in the interlocking domains of individual abilities and attributes, relationships, and significant life activities (Berliner & Elliott, 2002; Briere & Scott, 2006; Courtois, 2010; Frazier et al., 2009; Koch, Douglas, Nicholls & O'Neill, 2006). Individuals who have experienced CSA are de facto at relatively high risk for later psychological difficulties due to their young age and the particular form of trauma exposure. ...
... Young age at the time of maltreatment or trauma is known to increase the risk for later psychological difficulties (Briere & Scott, 2006; Kaplow & Widom, 2007; Manly, Kim, Rogosch & Cicchetti, 2001; Vogt, King & King, 2007). As well, CSA and violence or threat inflicted by another person is known to be associated with greater risk for later psychological difficulties than forms of trauma such as a involvement in a motor vehicle accident or natural disaster (Briere & Scott, 2006; Koch et al., 2006; Ozer, Best, Lipsey & Weiss, 2008). In addition to the age of the individual and nature of the trauma, several other factors must be considered in evaluating whether and how the index sexualized activity influenced risk for later psychological difficulties. ...
Article
Full-text available
Though childhood sexualized assault (CSA) in- creases risk for varied psychological difficulties, no single condition, syndrome, or set of difficulties is reliably associated with such experiences. CSA likely disrupts or impairs normal development in complex ways that depend on the risk and resilience factors present before, during, and after CSA. CSA characteristics that increase risk for later difficulties include young age, trauma inflicted by another person, number of occurrences, violence or intrusiveness, betrayal of trust, ad- verse peri-traumatic reactions, negative reactions from others following disclosure, and a context of previous sexualized assault or maltreatment. Resilience increases with positive self-esteem, better intellectual functioning, good self-control, positive social support, and early therapeutic intervention. CSA is associated with impaired psychological development, mental health disorders, behavioural and relationship difficulties, physical health problems, reduced intellectual function, lower educational achievement, lower occupational attainment, and reduced lifetime income. Any particular difficulty may be problematic in its own right and may also contribute to other difficulties in the interlocking domains of individual abilities and attributes, relationships, and significant life activities. In individual forensic assessment cases, general evidence on CSA risk/resilience and impacts can be used in combination with the lifespan developmental analysis (Barnes & Josefowitz, Psychological Injury and Law, 2014),
... The paucity of research regarding the effects of ethnic differences and language barriers becomes more troubling in light of the increasing cultural diversity common to many countries. The U.S. Census Bureau predicted that by 2030, 40% of adults and 48% of children in the United States will be ethnic minorities (Koch, 2005). Canada and Europe are also experiencing significant immigration and diversification, as immigration currently accounts for over 50% of the growth of Canada's population (Koch, 2005) and cross-border migration accounted for 75% of the population increase in the European Union (Eurostat, 2003). ...
... The U.S. Census Bureau predicted that by 2030, 40% of adults and 48% of children in the United States will be ethnic minorities (Koch, 2005). Canada and Europe are also experiencing significant immigration and diversification, as immigration currently accounts for over 50% of the growth of Canada's population (Koch, 2005) and cross-border migration accounted for 75% of the population increase in the European Union (Eurostat, 2003). ...
Article
Full-text available
With the ever-increasing cultural diversity in the United States, the need for malingering assessment instruments that are valid in diverse cultures and languages has become increasingly apparent. Although language-based tests are obviously problematic when applied to non-English speaking individuals, even nonverbal tests may have subtle (or blatant) biases that render normative data from U.S. samples inaccurate. This study focused on the applicability of a nonverbal malingering test, the Dot Counting Test, in a non-Western population undergoing forensic evaluation for a civil lawsuit. The DCT was administered to 105 Punjabi Sikh litigants, and the distribution of scores and associations with clinical and demographic variables was analyzed. Results demonstrated that a large proportion of seemingly honest respondents (based on clinician ratings) were misclassified as likely malingering based on the DCT. The implications for malingering assessment are discussed.
... Are there neurological findings that support its validity? Or, is it only a reflection of a preexisting negativity (Koch et al. 2006)? Do some individuals with mild traumatic brain injury (mTBI) develop post-concussive syndrome and constitute the " miserable minority " (Ruff and Jamora 2009)? ...
... Psychologists have engaged in this type of work since the adversarial divide was apparent in the area, across the defense and plaintiff sides in tort and related civil legal venues. However, the field of personal or psychological and psychiatric injury and law has only recently coalesced into a coherent discipline with its own books (e.g., Koch et al. 2006; Schultz and Gatchel 2005; Young et al. 2006), its own journal (Psychological Injury and Law; springer. com), and its own society (Association for Scientific Advancement in Psychological Injury and Law; ASAPIL; www.asapil.org). ...
Article
This literature review of the major topics in the field of psychological/psychiatric injury and law is aimed at developing practice in the area. The field is a fast-developing one, with over ten major topics that it needs to integrate. In particular, the present review focuses on current work on: law (evidence, tort); forensic psychology; assessment and testing; psychological injuries (posttraumatic stress disorder, chronic pain, traumatic brain injury, other); the APA DSM-5 draft (Diagnostic and statistical manual of mental disorders; American Psychiatric Association 2010); malingering; causality; multicultural considerations; disability; the American Medical Association (AMA) Guides to the evaluation of permanent impairment (Rondinelli et al. 2008); models; and treatment. At the end of each section of the article, practice comments introduce critical issues in applying the research to psychological work in the area. Whether undertaking tort evaluations, disability, and treatment plan assessments or treating individuals with psychological injuries, the professional needs state-of-the-art information in all the areas listed in order to remain scientifically informed, comprehensive, and impartial. The article concludes with recommendations for an integrated field in psychological/psychiatric injury and law, study in the field, research in its major areas, best practice policies, for example in assessment and treatment, and model building. KeywordsPsychological injury–Literature review–Practice recommendations–Court
... Conversely , other studies have found that malingered reports contain an " over the top " (i.e., exaggerated) quality (e.g., Efendov et al. 2008; Elhai et al. 2001; Porter et al. 2007). Research has demonstrated that simulators of PTSD tend to inflate their symptoms on a variety of clinical scales concerning both psychological and physical well-being without detection (e.g., Gray et al. 2010;), and that trauma and validity scales often are not effective in discriminating symptom veracity (e.g., Edens et al. 1998; Koch et al. 2006; Peace et al. 2010). This suggests that malingerers show a level of sophistication in symptom reporting, and that research needs to consider whether malingered symptomology varies as a function of trauma type and/or the context (i.e., motivation) of a claim (e.g., see Haley 1989; Porter et al. 2007). ...
... Many legal cases exist based on the principle of " psychological damages " resulting from a traumatic incident (Iverson and Lange 2006). As a result, the fabrication of psychological symptoms is a legitimate concern when evaluating reports of distress associated with traumatic experiences, particularly in cases of civil or criminal litigation (e.g., Burges and McMillan 2001; DeClue 2002; Koch et al. 2006; Lees-Haley 1989; Rogers 2008). Research to date has primarily focused upon malingering in the context of civil litigation processes, wherein compensation is the prime motivator for malingered symptom profiles (e.g., Edens et al. 1998; Frueh and Elhai 2002; Singh et al. 2007). ...
Article
Full-text available
Psychological disorders associated with traumatic events, such as post-traumatic stress disorder (PTSD), may be prone to malingering due to the subjective nature of trauma symptomology. In general, symptoms tend to be inflated when an external reward (i.e., compensation) is associated with the claim. The present study was designed to test whether malingered claims of PTSD symptoms differed as a function of the type of trauma being malingered (accident, disaster, sexual assault) and the motivation for malingering (compensation, attention, revenge, no motivation). Participants were randomly assigned into conditions, given malingering instructions, and then asked to complete three measures of trauma symptoms (Impact of Event Scale—Revised; Post-Traumatic Stress Disorder Checklist; Trauma Symptom Inventory). Results indicated that participants in the sexual assault condition produced higher symptom reports on nearly all scales. Revenge and compensation motivations yielded elevated symptom scores. Further, individuals rated high in fantasy proneness and dissociation produced elevated scores on atypical responding and most clinical scales. More research is needed to examine the extent to which different motivations and trauma types influence symptom reporting. KeywordsMalingering–PTSD–Motivation–Trauma–Fantasy proneness–Dissociation
... Spain psychological injury as an item to be estimated under the category of moral injury. Whilst physical injury is estimated on compensation tables, the estimation for compensation of psychological injury sustained in a motor vehicle accident have not been clearly established due to the difficulties in estimating claims in monetary gains (Douglas, Huss, Murdoch, Washington, & Korch, 1999; Koch, Douglas, Nicholls, & O'Neill, 2006; Santos, 1989). According to Spanish Law 30/1995, psychological injury is defined as injury sustained as a result of having undergone a traumatic experience which, to a greater or lesser degree, may adversely affect a person's everyday life in terms of family relationships, social relationships, work, and/or leisure (Iglesias, 1996). ...
... According to Spanish Law 30/1995, psychological injury is defined as injury sustained as a result of having undergone a traumatic experience which, to a greater or lesser degree, may adversely affect a person's everyday life in terms of family relationships, social relationships, work, and/or leisure (Iglesias, 1996). Though legislators had been well aware of the psychological injuries sustained in Motor Vehicle Accidents (MVAs), they had often been reticent to consider them as an element to be evaluated in claims for victims compensation on the basis of the difficulties in assessing psychological injuries and hence the creation of objective compensation tables (American Medical Association, 1995; Criado del Río, 1999; Muller, 1995; Pérez & García, 1991) primarily due to the subjective, individual and personal nature of psychological injuries (Kane, 2006; Koch, et al., 2006). As these deficiencies have now been overcome, the Spanish law has recently introduced psychological injury as an item for victim compensation. ...
Article
Full-text available
The Spanish Law 30/1995 concerning civil liability in motor vehicle accidents (MVA) has included, under the precept of moral damage, the compensation of victims of psychological injury. The literature has identified PTSD and the indirect measurements or secondary disorders i.e., depression and dystimia, as psychological injury of an MVA. Nevertheless, under civil law, the diagnosis of PTSD alone does not constitute sufficient evidence given that in legal terms faking or false testimony must be detected and eliminated before an expert testimony can be admissible. In this context, and in order to assess the ability of malingerers to fake psychological injury in MVA, a total of 105 naïve participants i.e., untrained in psychopathology, and who had never been involved in a traffic accident in which they had sustained physical or psychological injury, were asked to feign they had suffered psychological injury as a consequence of a MVA. One week after self-training, they were evaluated on the MMPI-2. The results show that participants were able to fake both the direct and indirect symptoms of psychological injury of an MVA. The assessment of the predictive capacity of the validity and configurations scales of the MMPI-2 for effective simulators of moral damages revealed a wide margin of error: 26 subjects (24.76%) were perfect simulators. Finally, the results for the assessment of psychological injury of MVA are discussed and guidelines are recommended for detecting faking.
... brain injury occurring consequent to MVCs as well as the legal issues that are relevant to the assessment and management of MVC-related physical and psychological sequelae. More recent book publications have adopted this style of analysis, addressing the interacting infl uences of PTSD, injury, and pain following traumatic injury ( Koch et al., 2006 ). Other book publications have emphasized the complexity of evaluating and managing such co-morbid conditions and determining causality in the context of litigation ( Young et al., 2006 Young et al., , 2007 ). ...
Chapter
This chapter provides an overview of the structure and content of the book. A chronological account of the assessment and treatment of collision-related physical and psychological injuries is presented. This includes the scope and significance of motor vehicle collisions (MVCs); the immediate physical and psychological aftermath of MVCs; primary care management of acute injury, pain, emotional distress and impairment; specialized management of chronic physical and psychological consequences of MVCs; and those medicolegal issues relevant to determining the extent of physical and psychological injuries and to securing care and compensation for such injuries. The chapters proceed from the emergency room, to the initial visits to the family physician's office, to managing chronic physical and psychological symptoms, and to managing medicolegal issues.
... Research has shown that women have a greater risk of PTSD from motor vehicle accidents (Douglas & Koch, 2000;Koch, Douglas, Nicholls & O'Neill, 2005) than men have (Berna et al., 2012). The greater incidence of PTSD in women may be part of the more general phenomenon in which women display more psychological distress than men, irrespective of their exposure to traumatic stressors (Almeida & Kessler, 1998). ...
Article
Full-text available
Orientation: Research into the long-term effects of motor accidents on the work performance and careers of victims in South Africa is limited. Results of this research are important for employers who must assist the employees after they return to work.Research purpose: The purpose of this study was to contribute to research on the effects of the injuries by investigating the relationship between the severity of the injuries and the careers and growth potential of victims.Motivation for the study: Employers could use the information on the effects of the injuries on the careers of victims to plan interventions and job accommodations to retain employees and to manage their well-being and performance.Research design, approach and method: The author conducted a quantitative survey on a purposive sample (N = 199) of adult victims of motor vehicle accidents in 2010 in South Africa. She used descriptive and inferential statistics to analyse the data.Main findings: The author observed a number of significant relationships between the effects of the different injuries on the careers and growth potential of victims.Practical/managerial implications: Organisations and managers need to recognise the physical and psychological effects of injuries victims sustain in motor accidents and the associated responsibility of organisations to accommodate these employees.Contribution/value-add: The findings of the study can add to the literature and provide insights into the consequences of the injuries. They also provide information that can assist organisations to create an awareness of job accommodation and employee wellness of accident victims.
... These adults often seek remedies through civil proceedings, thus requiring a forensic assessment to determine the nature and extent of psychological injuries. Such assessments must proceed within an appropriate forensic framework (Kane & Dvoskin, 2011; Koch, Douglas, Nicholls, et al., 2006; Young, Kane & Nicholson, 2007), but pose unique challenges as compared to those encountered in psychological injury assessments related to adult trauma. Even identifying appropriately neutral language to describe CSA experiences can require thought and care, as discussed below. ...
Article
Full-text available
Many adults reporting childhood or adolescent sexualized assault (CSA) seek remedies through civil proceedings, thus necessitating a forensic assessment to determine the nature and extent of any psychological injuries related to such assault. Such assessments pose challenges, as CSA often occurred years earlier and may have affected not only immediate functioning but also later psychological maturation. The present paper explains how a lifespan developmental analysis can assist such assessments. The concepts of psychological development, attachment, developmental trajectory and risk and resilience can help in evaluating whether and how CSA affected normal psychological development, in determining the influence of risk factors other than CSA and in considering resiliency factors. Risk, resilience and psychological function must be examined in the domains of individual abilities and attributes, relationships and significant life activities both pre- and post-assault. Data on pre-assault risk, resilience and function can be used to estimate a “but for the assault” developmental trajectory that can then be compared to the individual’s actual developmental trajectory. This analysis, together with analysis of the severity of CSA, can assist in determining whether and how the CSA that is the basis for civil proceedings contributed to later life psychological injuries.
... The losses consequential to the pain disorder can be accentuated with the anger, frustration, and helplessness of being suspected of falsification when suffering is real. The progress made in medical treatment can be set back and new problems can develop in such circumstances [51]. As well, questioning the validity of a claim can provoke individuals who are augmenting or falsifying their pain disorder in litigation proceedings to engage in behaviors that worsen their condition. ...
Article
Understanding chronic pain requires an understanding of psychological factors related to the pain experience. This paradigm is the standard foundation for pain medicine as well as physical medicine and rehabilitation diagnosis and treatment. Pain patients with spine disease frequently present with a multifaceted array of physical and psychological aspects including depression, anxiety, traumatic stress, cognitive dysfunction, a potential for substance abuse, and regressed social functioning. An evolving standard of care mandates that prior to invasive pain therapies for spinal pain psychological suitability be determined. Spine pain disorders in the context of ongoing litigation present complex clinical situations which cannot be managed by medical treatments alone. The litigation will add stress and disruption to the medical diagnosis and treatment. The biopsychosocial model with inclusion of clinical psychologists as members of the treatment team is essential. This review will consider the important factors essential for a best practice approach to management of the spine pain patient with coexisting litigation.
... the way with(2006,2007) have followed suit with their two books. These authors collaborated in founding the present journal, Psychological Injury and Law (and the association mounted to house it, Association for Scientific Advancement in Psychological Injury and Law), along with Michael Finch, who took charge of the legal component of the journal.Koch et al. (2006)wrote another critical book on psychological injury and law, focusing on Posttraumatic Stress Disorder (PTSD). ...
Article
In this introductory article to the special series of articles written to initiate the new journal, Psychological Injury and Law, I provide the background and impetus for this fast-growing area as a distinct field of scientific study. Professionals working in the area need to be aware of its diverse components, from evidence law and forensic psychology to disability and assessment, to its three core areas of Posttraumatic Stress Disorder and other distress, chronic pain, and traumatic brain injury, as well as issues such as malingering. I provide summaries of the articles in this special series that appear in this inaugural issue. The remaining articles of the special series of articles to introduce the journal are presented in the next two issues.
... Miller's (1961) widely cited study implying that compensation neurosis represented, to a considerable degree, conscious malingering brought the concept from the psychoanalytic to the behavioral realm. Despite criticisms that Miller's investigation was methodologically flawed (Kolbinson et al. 1996), it has continued to influence the courts (Koch et al. 2006). Added to the concept that compensation neurosis represents malingering is the belief that claimants experience a " magical cure " immediately following the settlement of their claims, although this has been established as generally inaccurate (Mayou 1995; Mendelson 1995; Merskey 1986; Scholten-Peeters et al. 2003). ...
Article
Full-text available
Approximately half of the state legislatures in the USA have enacted tort reform, generally focused on reducing noneconomic damages such as those awarded for pain and suffering of traumatically injured parties. Traumatic injury has been empirically associated with the development of chronic pain, which in turn has been associated with the concept of human suffering. This analysis examines the meaning of suffering within the context of traumatically induced chronic pain, recognizing that this population is at heightened risk of experiencing long-term emotional as well as physical pain. Factors contributing to profound suffering include the potential development of post-traumatic stress disorder, depression and anxiety, role/identity loss, maltreatment by a medical system generally inept in its management of chronic pain, and the negative manner in which personal injury victims are often treated by the legal system. While the American medical system struggles to identify suffering, the legal system—through tort reform—has chosen to simply ignore it, demonstrating little concern for the integrity of the vulnerable chronic pain sufferer. In doing so, the “destructed” chronic painient is further “deconstructed”. We argue that by limiting the size of settlements and jury awards, tort reform serves to potentially deny personal injury victims of a critical vehicle for finding meaning in their suffering, and accordingly limits their likelihood of achieving relief. KeywordsTraumatic injury chronic pain-Suffering-Tort reform-PTSD-Depression-Anxiety
... One important pre-trauma variable to consider is personality. Miller (2003) argued that high negative emotionality is a risk factor for the onset of PTSD to trauma (also seeMiller et al. 2004).Koch et al. (2005Koch et al. ( , 2006) posited that PTSD is an extreme state of negative emotionality comprised of pre-existing superordinate negative emotionality, exacerbation of the negative emotionality by the stress of an index event, and unique dysfunctional characteristics related to PTSD. They concluded that it may be that PTSD reflects a general negative affectivity. ...
Article
This article briefly reviews the literature on three areas of psychological injury, post-traumatic stress disorder, chronic pain, and traumatic brain injury, preparatory to presentation of an integrated biopsychosocial and forensic model of multifactorial causality. The model is the first in the field to (a) cover in one model the three types of psychological injury, (b) while including a full range of causality factors relevant to forensic psychology (such as pre-event, event-, post-event, and unrelated factors), and (c) while addressing the relevance of biopsychological and stress as a cohering factors in all conditions. (d) The model emphasizes the importance of individual differences, for example, in causality of symptom presentation. (e) The model acknowledges that in individual evaluations, psychologists need to consider threats to validity, response biases, and possible malingering, and verify whether pre-event factors fully explain post-event presentation.
... Certain scales may be more or less sensitive to subtle variations over time in symptom endorsement. Standardized and consistent approaches to deception detection are essential in clinical and forensic contexts (e.g., Koch et al. 2006; McCann 1998; Rogers 2008). While results in this research indicate that fabricated symptomology is inflated, reliable clinical indicators of deceptive symptoms were not found on the measures used in this study. ...
Article
Full-text available
False allegations of victimization typically are accompanied by malingered emotional symptomology to corroborate claims. This analog study was designed to compare truthful and fabricated symptom profiles on measures of post-traumatic stress (i.e., Revised Impact of Event Scale, Post-Traumatic Stress Disorder (PTSD) Checklist, Trauma Symptom Inventory) and levels of symptom consistency over time. Participants (undergraduate students) described their mental health symptoms for both traumas at time 1 (N = 291), time 2 (N = 252, 3month), and time 3 (N = 181, 6months). Results indicated that fabricated traumas were associated with inflated symptom profiles. Validity scales were not effective at discerning symptom veracity, although reports could be discriminated somewhat by atypical responding and clinical scales. PTSD symptoms in malingerers also were reported more consistently over time. This research offers applicable information for identifying feigned traumatic stress. KeywordsTrauma symptoms-Malingering-PTSD-Consistency-False allegations
Chapter
Roughly 25–50% of civil rights and tort cases, respectively, involve psychologists. These experts assess the causal relationship between events and psychological injuries. Researchers have written about the practical aspects of conducting these evaluations under typical circumstances. However, this chapter will specifically focus on trauma and forensic mental health evaluations in the context of civil rights litigation involving police misconduct. We will discuss the obstacles faced by plaintiffs seeking justice for their trauma from police misconduct, and we will introduce some considerations for psychologists retained by plaintiffs or defendants in these cases.
Chapter
This article presents a concise overview of issues arising in forensic neuropsychological assessments of traumatic brain injury. After a review of the definitions and epidemiology of head injuries, methods for rating their severity and outcome prognosis are discussed. Referral issues arising in both civil and criminal litigation are then presented, followed by an overview of the forensic neuropsychological examination process. Special attention is devoted to issues arising in the assessment of malingering, and to the forensic interpretation of neuropsychological test data. The article concludes by looking ahead to future developments in this field of expertise.
Technical Report
Full-text available
In March, 2011, the CPA Board of Directors launched a Task Force on Evidence-Based Practice of Psychological Treatments to support and guide practice as well as to inform stakeholders. Psychological health and disorders are clearly a priority for many of Canada’s stakeholder groups (e.g., Mental Health Commission of Canada, Treasury Board, Public Health Agency of Canada) and their effective treatment is an important priority for CPA as well. This document operationalizes what constitutes evidence-based practice (EBP) of psychological treatment. In terms of defining what is meant by “evidence”, the members of the task force were interested in a definition that was comprehensive enough to incorporate the following ideas: (1) peer-reviewed research evidence is central; (2) psychologists should be evidence-based not only in their general fund of knowledge but also in session-by-session work; (3) the process involves one of collaboration with a client/patient (rather than a top down process). Also advanced is a hierarchy of evidence that is respectful of diverse research methodologies, palatable to different groups of individuals and yet comprehensive and compelling. Evidence Based Practice of Psychological Treatments: A Canadian Perspective is intended to support Canadian psychologists in providing treatment that is guided by the best available evidence. This document is not intended to provide a comprehensive review of the EBP literature. Rather, it defines EBP and provides a hierarchy of available evidence. This document also contains several brief case examples from various areas of practice that serve to illustrate the manner in which the hierarchy can be applied to different presenting problems and populations. A series of extended vignettes also describe the process of EBP in terms of case conceptualization, initial and ongoing assessment, treatment planning and the implementation of psychological interventions. A guide for the general public and individuals with lived experience highlights the added value that psychologists bring to the understanding, assessment and treatment of mental and behavioral health problems. Also included in this document is a list of resource materials to help professional psychologists locate reliable information regarding EBP. Finally, we end with a set of recommendations to further advance the EBP of psychological treatments. Our intention for this document is to provide a set of guidelines that will foster interest, encourage development and promote effectiveness in EBP. We hope that the readers will find Evidence-Based Practice of Psychological Treatments: A Canadian Perspective useful as they seek to provide and implement the best possible psychological treatments. David J. A. Dozois, Ph.D. & Sam Mikail, Ph.D. Co-Chairs
Article
The system for assessing appropriate damages for individuals who have suffered a personal injury, caused by another person or persons is well established in the UK. A claimant, for example, who has been in a road accident, work accident, medical accident or negligent action can make a claim for his/her physical and psychological injuries, time off work and future disability, provided it is proven that another person(s) is responsible. The system involves obtaining, medical-legal evidence on the diagnosis, causation, treatment and prognosis of any injuries, physical or psychological. One key aspect of this covers the crucial issue of evidential reliability. This paper explains the key questions facing lawyers and experts alike in the UK; fundamental postulates or beliefs about evidence; ways to improve reliability; the relevance of pre-event history and improving evidential reliability via Part 35 questioning. The UK, along with the USA, has the most advanced and developed system of personal injury litigation process.
Chapter
In the second chapter in the present book on causality in the area of psychological injury and law, I present a new model that includes iatrogenesis among the various influences on individuals with psychological injuries. Much of the chapter deals with iatrogenesis, which has not been a central topic in psychology despite its importance in the medical field. I review other models in the area of psychological injury and law that include iatrogenesis, as well as the many terms related to it. This chapter and the prior one emphasize the need to conduct comprehensive assessments that are impartial and scientifically informed in order to evaluate effectively psychological injury determinations and their causality.
Chapter
To begin, this introductory chapter provides the reader with a detailed summary of the book. Next, it describes in depth the area of psychiatric/psychological injury and law. This book is about the major areas of psychiatric/psychological injury and law, and especially about scientific, impartial, and comprehensive approaches to malingering and its detection.
Chapter
This chapter is exclusively on PTSD (posttraumatic stress disorder). I compare and contrast four recent chapters written simultaneously on the topic of PTSD and its assessment in relation to malingering: in order, (a) Andrikopoulos and Greiffenstein (2012), (b) Rosen and Grunert (2012), (c) Lareau (2011), and (d) Howe (2012). The four works raise both general points and issues related to testing. Three of the four chapters involve assessment of PTSD in the neuropsychological context, but I focus mainly on their presentation of PTSD rather than on their treatment of TBI (traumatic brain injury) and of neuropsychology. There is much agreement over the four sources that I review, and I try not to be redundant in describing them; however, for psychological assessment of PTSD there is disagreement among them on what is effective in detecting malingering. Briefly, for PTSD assessment and the issue of malingering, Andrikopoulos and Greiffenstein (2012) valued the interview process, in particular; Lareau (2011) preferred psychophysiological testing as a quality indicator; and both Howe (2012) and Rosen and Grunert (2012) emphasized the use of several psychological tests in PTSD assessment, although they did not provide identical tests among their lists of recommended instruments.
Article
In-depth consideration of causality is central to the determination of responsibility in tort actions. If causality and responsibility are not immediately evident, and if psychological factors play a potentially significant role in the plaintiff's disability, the case may be set for trial. Adequately demonstrating the presence or absence of causality in depositions and in court requires that a psychologist (or other mental health professional) be retained as an expert to do a comprehensive assessment that will provide the court with sufficient information to assist with the determination of liability. That information must be valid, must be obtained using legitimate methods, and must present the information in a manner of value to the trier of fact (judge or jury). The psychologist must be well-acquainted with the requirements of the court, and the attorneys and judge must be sufficiently familiar with psychological concepts, in order for the members of the mental health and legal professions to meaningfully interact. This chapter and the three that follow will address these issues from the perspectives of both the psychologist and the court.
Chapter
The American legal system has developed procedures for the resolution of disputes related to civil wrongs, or torts. Psychologists have become an integral part of this system because of their expertise in evaluation of functional impairment and the determination of the causes of psychological symptoms and problems. This chapter focuses on tort cases and how psychologists may work with the courts to assist in resolution of these disputes. The first half of the chapter reviews the law as applied to tort cases and provides definitions of terms associated with tort cases, and distinctions between different kinds of torts. Some case law history is the next topic, and this first half concludes with a review of the Rules of Civil Procedure as applied to tort cases. The second half of the chapter reviews the psychological evaluation of plaintiffs. Included is a brief introduction to a five-stage model of assessment of damages and causation. This section provides references to applicable standards and guidelines and some examples from the research in trauma and comorbidity.Keywords:tort;personal injury;forensic evaluation;trauma
Article
The purpose of this article is to clarify the current state of describing traumatic reactions resulting in post-traumatic stress disorder (PTSD) so that the disorder can be understood, assessment and treatment can be optimised and recovery can be facilitated. This article describes what PTSD is and how it can be most effectively treated. The key challenges to PTSD diagnosis, treatment and psychoeducation are discussed.
Article
Full-text available
Purpose – The purpose of this paper is to address how context for malingering and the provision of incentives influence malingered symptom profiles of post-traumatic stress disorder (PTSD). Design/methodology/approach – A 2 (case context)×3 (incentive) factorial design was utilized. Participants (n=298) were given an incentive (positive, negative, or no incentive), randomly assigned to a criminal or civil context, and asked to provide a fake claim of child abuse with corresponding malingered symptoms of PTSD. Under these conditions, participants completed several questionnaires pertaining to symptoms of trauma and PTSD. Findings – Results indicated that negative incentives were primarily associated with lower symptom scores. Therefore, “having something to lose” may result in more constrained (and realistic) symptom reports relative to exaggeration evidenced with positive incentives. Originality/value – These results have implications for forensic settings where malingered claims of PTSD are common and incentives for such claims (e.g. having something to gain or lose) frequently exist. Previous studies have failed to address incentives (positive and negative) in relation to a crime (i.e. abuse) that can span both criminal and civil contexts.
Article
Although a plethora of studies focus on jury decision making in sexual harassment cases, few studies examine damage award assessments in such suits, and even fewer explore the impact of psychological injury on jurors’ liability and damage award assessments. In the present study, 342 undergraduates read a hostile environment sexual harassment case that manipulated the plaintiff’s psychological injury level (severe vs. mild vs. control) to investigate whether males and females made different damage decisions. Males using a reasonable person standard found more liability as the severity of the plaintiff’s psychological injury increased. However, males using a reasonable woman standard found less liability with the addition of any psychological injury information. Similarly, for mild and severe injuries, males using the reasonable woman standard awarded lower damages than males using the reasonable person standard. Females tended to find more harassment than males, but psychological injury and legal standard had little impact on females’ legal decisions. We discuss these findings in light of the positive relationship often observed between the plaintiff’s injury severity level and pro-plaintiff verdicts.
Article
This article was written to introduce readers to the bodies of work that inform experts who conduct evaluations of plaintiffs or offer generic testimony in cases involving claims of psychological injuries in the aftermath of sexual trauma, including childhood sexual abuse, adult sexual assault, and sexual harassment. In addition to summarizing the research literatures on those three areas of maltreatment, it reviews what mental health experts should know about our laws, about professional standards for evaluations, and about other relevant areas of research, such as assessment of posttraumatic stress symptoms, disclosures by young children, “normal” childhood sexual behaviors, “repressed” or “recovered” memories, memory and trauma, memory distortions, and resilience.
Article
In a small number of felony murder cases, posttraumatic stress disorder (PTSD) has been used as an affirmative defense to plead not guilty by reason of insanity or to argue for diminished capacity as a mitigating factor at sentencing. This article traces the history of PTSD as a legal defense; describes the clinical criteria for diagnosing and assessing PTSD; outlines the legal criteria for the affirmative defense of not guilty by reason of insanity (NGRI) and mitigation on the grounds of diminished capacity; and discusses the applications and pitfalls of using PTSD as an exculpatory factor in crimes of violence, including murder.
Chapter
The dictionary of terms presented in this chapter concerns the specific terms of causality and causation, key terms related to these terms, and auxiliary terms such as expert witness and trier of fact. For straightforward terms, often, we give only one definition is given and it is derived from a standard source, such as a law dictionary or a psychology dictionary. However, for variation, the definition may be taken from a different source. For important terms, where dictionaries clearly differ in definition, or are complementary, we may provide several definitions, a procedure which facilitates grasping the differences. In addition, this approach also helps prepare discussion of clear differences in definition for the same term across domains, for example, in psychology and in law.
Article
This paper uses the psychological and legal concept of "psychological injury" as an illustration of the evolving market for psychological knowledge and of necessary changes in the graduate and internship training of clinical psychologists. Our current graduate and internship training fails many of our students through neglecting important areas of knowledge and experience. In this paper, I discuss the importance of exposing graduate students to: a) the economics of mental health; b) professional roles involving knowledge dissemination outside traditional academia; c) information needs of direct and indirect consumers of psychological knowledge; and, d) communication skills necessary when interacting with nonpsychologists. Suggestions are made for the improvement of our graduate training programs, including more explicit acknowledgement of the likely career paths of most of our graduates. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This literature review of the major topics in the field of psychological/psychiatric injury and law is aimed at developing commentary for practice in the area. The field is a fast-developing one, with over ten major topics that it needs to integrate. In particular, the present review focuses current work on: law (evidence, tort); forensic psychology; assessment and testing; psychological injuries (posttraumatic stress disorder, chronic pain, traumatic brain injury, other); the APA DSM-5 draft (Diagnostic and statistical manual of mental disorders; American Psychiatric Association 2010); malingering; causality; multicultural considerations; disability; the American Medical Association (AMA) Guides to the evaluation of permanent impairment (Rondinelli et al. 2008); models; and treatment. At the end of each section of the article, practice comments introduce critical issues in applying the research to psychological work in the area. Whether undertaking tort evaluations, disability, and treatment plan assessments or treating individuals with psychological injuries, the professional needs state-of-the-art information in all the areas listed in order to remain scientifically informed, comprehensive, and impartial. The article concludes with recommendations for an integrated field in psychological/psychiatric injury and law, study in the field, research in its major areas, best practice policies, for example in assessment and treatment, and model building. KeywordsPsychological injury–Literature review–Practice recommendations–Court
Article
This paper presents a model of chronic pain [Young and Chapman (Pain, affect, nonlinear dynamical systems, and chronic pain: Bringing order to disorder. In G. Young, A. W. Kane, & K. Nicholson (Eds.), Causality of psychological injury: Presenting evidence in court (pp. 197–241). New York: Springer, 2007)]. It includes extensive coverage of the systems perspective. The paper expands the model to medically unexplained symptoms and provides a developmental model of how these may unfold and influence adult presentation after events such as accidents. Similarly, the model is examined for the developmental roots of personality disorder. The paper examines other threats to validity of diagnosis in cases of psychological injury.
Article
In several ways, the book on motor vehicle collisions by Duckworth, Iezzi, and O’Donohue (2008) breaks new ground and should be considered a must-read for workers in the area of psychological injury and law. The editors have assembled a team of expert authors who have cogently analyzed the scientific evidence in the area of motor vehicle collisions and their aftermath, while calling for more research. The book is replete with information that will help practitioners understand and deal with cases involving conditions such as chronic pain, posttraumatic stress, and traumatic brain injury. Practitioners will learn about complications in such cases, including threats to validity and legal aspects. The inclusion of chapters from a medical perspective is a welcome innovation. The book is only lacking in that, although assessment is considered throughout, chapters specifically addressing this topic are not included. The book review concludes that the Motor vehicle collisions book by Duckworth et al. should be included as part of the growing list of excellent resources in the area of psychological injury and law.
Article
This article elaborates definitional and conceptual issues relevant to the field of psychological injury and law. It reviews the literature in the major areas that mark the field—law, forensic psychology, disability, and assessment/malingering. To meet admissibility requirements of testimony in court, psychologists and other mental health professionals need to maintain a comprehensive, impartial, and scientifically informed approach to assessments based on a state-of-the-art knowledge, such as made available in this journal.
Article
This article provides a commentary on the proposed Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 changes with respect to diagnosing posttraumatic stress disorder (PTSD) in diverse cultural groups in clinical and forensic settings. PTSD is the most common diagnosis in personal injury litigants (Koch et al. 2006). By reviewing the symptoms that have been changed in the DSM-5 draft for PTSD in terms of ethnoracial and minority–cultural factors, this article highlights the lack of data needed in the area and that the DSM project should pay more attention to such factors. KeywordsPTSD-Group differences-DSM-5
Article
Full-text available
Standard clinical assessment of psychological injury does not provide valid evidence in forensic settings, and screening of genuine from feigned complaints must be undertaken prior to the diagnosis of mental state (American Psychological Association, 2002). Whereas psychological injury is Post-traumatic Stress Disorder (PTSD), a clinical diagnosis may encompass other nosologies (e.g., depression and anxiety). The assessment of psychological injury in forensic contexts requires a multimethod approach consisting of a psychometric measure and an interview. To assess the efficacy of the multimethod approach in discriminating real from false victims, 25 real victims of gender violence and 24 feigners were assessed using a the Symptom Checklist-90-Revised (SCL-90-R), a recognition task; and a forensic clinical interview, a knowledge task. The results revealed that feigners reported more clinical symptoms on the SCL-90-R than real victims. Moreover, the feigning indicators on the SCL-90-R, GSI, PST, and PSDI were higher in feigners, but not sufficient to provide a screening test for invalidating feigning protocols. In contrast, real victims reported more clinical symptoms related to PTSD in the forensic clinical interview than feigners. Notwithstanding, in the forensic clinical interview feigners were able to feign PTSD which was not detected by the analysis of feigning strategies. The combination of both measures and their corresponding validity controls enabled the discrimination of real victims from feigners. Hence, a protocol for discriminating the psychological sequelae of real victims from feigners of gender violence is described.
Article
A large body of empirical evidence has accumulated over the past decade documenting the psychiatric and emotional consequences of racism and racial discrimination. Still, little has been written in the legal or psychiatric assessment literature that is focused on describing the direct and specific effects of racism and offering guidance to forensic psychiatrists in understanding, assessing, and treating the race-based stress reactions that may occur as a result of exposure to racial discrimination or harassment. This article uses the analysis of a case study to illustrate and extend previous work on the evaluation of racial discrimination by providing a guide to the forensic assessment of the psychiatric and emotional impact of race-based encounters--a guide that can be used both in preparing expert reports and in developing treatment approaches.
Article
This paper discusses the limits of expert opinion on posttraumatic stress disorder (PTSD) in personal injury claims. The construct of PTSD is hampered by several empirical limitations. Multiple reliable measures of PTSD exist, but have not been evaluated sufficiently within litigating samples and are infrequently used by forensic assessors. Common methods for trauma screening appear insensitive. Opinions about causation of PTSD and disability are complicated by retrospective memory biases, as well as the failure of most anxiety disorders to be detected within primary medical care. PTSD appears to have a steep spontaneous remission curve during the first year, but at least 10% of trauma-exposed people suffer chronic distress. Little is known about the course beyond 1 year. Efficacious psychological treatments have been developed for PTSD, but are not in common use limiting claimants' access to rehabilitative treatments. Research on functional disability associated with PTSD is in its infancy, but it seems likely that PTSD will account for only a part of the variance in work disability. We provide suggestions for improving forensic practice, advising the courts about the limitations of forensic opinions, and necessary research.
Article
The use of effort tests is standard practice in forensic neuropsychology. There is a tremendous amount of good information available in test manuals and the research literature regarding the proper and responsible use of these tests. However, it is clear that there are numerous ethical issues and considerations associated with the assessment of exaggeration, poor effort, and malingering. Many of these issues are discussed, and recommendations are provided.
Article
Full-text available
My commentary is directed to one important feature of the new Restatement (Third) of Torts: General Principles (Discus-sion Draft) ("Discussion Draft") 1 —the decision to remove liability for emotional harm from the core of tort law. As a Torts professor, I am very attracted to the Discussion Draft because to a large extent it tracks the way I structure and teach torts to first year students. It reflects what Professors Jack Balkin and Sanford Levinson de-scribe as the pedagogical canon in torts, 2 by highlighting those top-ics and subtopics that most professors emphasize in their scaled-down Torts course and including the material that most agree every beginning law student should know. I am not so sure that the Discussion Draft responds as well to the needs of practitioners and judges who have already passed the course in Torts. For me, one test of a Restatement is whether it will help lawyers and judges argue and decide the non-routine case, where precedent is scarce and the stakes seem high. An irony of the Restatement process is that a Restatement is needed to provide some guidance for legal actors in cases where the boundaries and catego-* Professor of Law, University of Pittsburgh. I wish to thank Vivian Curran for her in-sights which I readily incorporated into this Commentary. 1. RESTATEMENT (THIRD) OF TORTS: GENERAL PRINCIPLES (Discussion Draft Apr. 5, 1999) [hereinafter Discussion Draft]. This commentary focuses solely on the Discussion Draft prepared by Gary Schwartz and the critique of that draft contained in John C. P. Goldberg & Benjamin C. Zipursky, The Third Restatement and the Place of Duty, 54 VAND. L. REV. 657 (2001). I have not attempted to comment on the alternative draft prepared by Harvey Perlman.
Article
Full-text available
Posttraumatic stress disorder (PTSD) can be one of the debilitating and harmful effects of sexual assault. Although many forms of intervention exist for rape-related PTSD, only a few well-controlled studies have been conducted to systematically evaluate the treatment response of women who have been the victims of sexual assault. Overall, cognitive-behavioral interventions for rape-related PTSD, with single or multiple treatment components, have been found to result in a decrease or remission of posttrauma sequelae when compared to no treatment or wait-list control conditions. This article highlights the general methodological issues that are pertinent in the design of studies to evaluate the treatment outcome of rape-related PTSD. The wide range of psychological interventions for the treatment of postrape sequelae are reviewed and special attention is given to cognitive-behavioral interventions because these treatments have been subjected to more rigorous empirical examinations. Finally, suggestions are made to improve the assessment of rape-related PTSD and to predict treatment response in rape victims.
Article
Full-text available
Daubert v. Merrell Dow Pharmaceuticals, Inc. established guidelines for screening the admissibility of scientific evidence and overruled the Frye “general acceptance” doctrine. Guidelines more akin to those advocated by psychologists to assess the trustworthiness of the expert testimony were established in light of the Federal Rules of Evidence on the reliability, relevance, and prejudicial or probative nature of the information. Forensic psychological experts will have to be explicit about the scientific foundations of their opinions. The more flexible formula for the admission of scientific evidence may exert greater quality control than the Frye test, and enhance the relationship of psychology and law by eliminating some sources of controversy within the professional community over expert witnesses. Research needs flowing from the new standards are identified.
Article
Full-text available
The MMPI-2 is one of the most widely used instruments in forensic neuropsychology. Unlike most tests, it has the advantage of containing validity scales that assist the examiner in determining the level of cooperation of the examinee. Scales that provide information for evaluating the validity of an MMPI-2 profile include VRIN, TRIN, L, F, K, F -K, FB, F(p), FBS (Fake Bad Scale), Total Obvious -Subtle, Ds, Dsr, and Ego Strength. This article discusses research available when considering the applicability of these procedures in the context of challenges to their scientific reliability and validity in legal proceedings, according to the standards set forth in Daubert v. Merrell Dow Pharmaceuticals, Inc.
Article
Full-text available
The study was a cross-sectional survey using a convenient sample of 186 respondents to examine the perception of sexual violence against women and help-seeking responses to sexual victimization among four Asian groups; Chinese, Japanese, Korean, and Southeast Asian (Cambodian, Laotians, and Vietnamese). The authors examined respondents' perception of the severity of the problem of sexual violence against women for Asian American populations, the perceived relationships between perpetrators and victims, the preferred preventive measures, and help-seeking responses. Findings indicated a split opinion among the four Asian groups regarding the perceived severity of the problem. There was a perceived insignificant role of family members in inflicting sexual violence, a general tendency of not choosing an immediate, confrontative stance against the perpetrator to stop sexual violence, and a preference to utilize help from the private domain in situations of sexual victimization. In addition, findings of the study supported the role of shame in deterring individuals from seeking outside professional help and demonstrated the existence of inter-group differences among various ethnic groups. At the same time, findings of the study raise important questions pertaining to the role of family members in sexual victimization of women, changing perceptions, inter-group differences, and the importance of localized knowledge in generating intervention efforts. In addition, findings of the study challenge a simplistic view of the reluctance of Asian American populations to utilize outside professional help. Implications for developing culturally relevant interventions for prevention and treatment as well as future research are discussed.
Article
Full-text available
The Impact of Events Scale (IES) has been characterized as one of the most widely used measures of the subjective psychological distress associated with traumatic events. However, the scale may measure other aspects of events, such as the cognitive accessibility of an event, as well as emotional distress or symptoms of Posttraumatic Stress Disorder (PTSD). To explore this possibility, 58 Texas community college students (35 women, 23 men) completed the scale with the target “stressor” being the worst movie or television show they had seen recently. Analysis showed that participants' scores approximated IES ranges often associated with significant emotional distress or PTSD. Insofar as the IES measures the memorability, cognitive accessibility or other aspects of events instead of psychopathology associated with events, it may produce misleading results when used as a measure of PTSD or emotional distress.
Article
Full-text available
Questioned the existence of sex bias in the clinical diagnosis of both borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD). Social workers, psychologists, and psychiatrists ( N = 1,080) were asked in a mail survey to assess the applicability of a number of diagnoses to a case tailored to include equal numbers of criteria for both BPD and PTSD. Half of the Ss received a "male" case; the other half received an identical "female" case. Results from the final sample of 311 Ss revealed sex bias in diagnosis, particularly with respect to sex of client, sex of clinician, and profession of clinician. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Full-text available
This study was intended to provide a normative comparison for determining the base rates of postconcussive syndrome (PCS) symptoms in patients from 4 medical departments of a health maintenance organization (HMO) and in people without acute medical or psychological complaints (controls). Recent research suggests that both neurologic and psychosocial factors influence these symptoms. Participants were 1,116 individuals who were surveyed regarding various symptoms, including those reported to be common in the PCS. Endorsement rates are presented for each PCS symptom for controls, each medical sample, and those people with a recent history of being knocked unconscious (2.3%), bumping their heads without losing consciousness (7.4%), and lawsuit involvement (6.8%), which were independently related to most PCS symptoms. The data indicate that neurologic, psychological, and environmental variables are related to having PCS complaints, and such factors should be considered before PCS complaints are used as evidence for brain damage. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Full-text available
If you are a psychologist who conducts child custody or personal injury evaluations, how confident are you that the traditional Minnesota Multiphasic Personality Inventory—2nd ed. (MMPI—2) validity scales and other potential MMPI—2 validity indicators are in fact useful for addressing the issue of response bias? This investigation contributes to the scientific database on the use of MMPI—2 validity indicators to detect response distortion. As the investigation represents empirical rather than analog data, it is of particular value to psychologists who engage in forensic assessment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Full-text available
The effectiveness of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; J. N. Butcher et al, 1989) Lie (L) and Infrequency (F) scales, relative to the Obvious-Subtle Index (O-S), the Positive Malingering (Mp) scale, and the revised Dissimulation scale in the detection of fake-good and fake-bad MMPI-2 protocols, was evaluated by asking college students to respond honestly, fake bad, or fake good on the MMPI-2. MMPI-2 protocols of participants asked to fake bad were compared with protocols from general psychiatric and forensic inpatient samples, and MMPI-2 protocols of participants asked to fake good were compared with MMPI-2 protocols of students asked to respond honestly. The F scale was superior in detecting faking bad, and the O-S index and the Mp and L scales were equally effective at detecting faking good. However, we caution against the use of the O-S index in the detection of fake-bad and fake-good responding. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
A Vietnam veteran was scheduled to stand trial with three other defendants on a federal charge of extortion. Subsequent to his arraignment, he entered weekly treatment for post-traumatic stress disorder (PTSD). As the trial date approach, his symptoms exacerbated to the point that it was necessary to commit him for 20 days of inpatient care. During this time, treatment for PTSD continued on a daily basis. On discharge, he was able to participate in his own defense and no longer manifested the symptoms that had precluded his standing trial. Some of the effects of PTSD on a defendant's behavior in the adversarial atmosphere of the court are discussed.
Article
Objective: This article reviews the issue of analgesic dependence from a psychobiological perspective. Specific attention is directed towards codeine dependence with the suggestion made that long-term codeine use may lead to and be maintained by worsening pain, associated withdrawal symptoms, and a fear of suffering, including depression. Data sources and data selection: The material is based on the current literature dealing with opiate dependence as well as the published and clinical experience of the author. Data extraction and synthesis: A dynamic paradigm for understanding opiate tolerance and withdrawal is described. The paradigm, with origins in basic research, serves to introduce the key concepts of the psychobiological nature of analgesic dependence, commonalities across drug-dependent behaviors, pain symptoms, and drug-seeking behaviors associated with prolonged codeine use, and the fear of suffering and depression. Conclusion: Analgesic dependence is best understood end managed from psychobiological perspective. Drug substitution in the treatment of codeine dependence is not recommended or is to be conducted with caution as alternative medication can maintain frightening withdrawal symptoms and drug-seeking behaviors. Fear of suffering is hypothesized to underlie the cognitive distress and depression associated with codeine dependence and must be addressed during the analgesic withdrawal program. Physicians are encouraged to motivate their analgesic dependent patients towards appreciating that the pain and suffering will decrease, rather than increase, with the successful removal of analgesic medications.
Article
This paper presents a review of the issues surrounding the diagnosis and epidemiology of post-traumatic stress disorder in adult survivors of traumatic events. The paper is presented in two sections. First, the diagnostic category of post-traumatic stress disorder as defined by the DSM-IV and the ICD-10 is reviewed. Issues to do with differential diagnosis, comorbidity and the validity of the three symptom clusters are examined in the light of recent empirical evidence. Second, recent epidemiological data is presented as it relates to five pertinent questions of epidemiological research.
Article
Violence against women is a significant public health, criminal, and social problem, but survey research with a focus on homeless women's experiences of violence is limited. Using self-report data from a probability sample of 974 homeless women in Los Angeles County, California, this study examines severity of homelessness, social and family characteristics, subsistence activities, and alcohol and drug abuse or dependence as predictors of major violence (i.e., being kicked, bitten, hit with a fist or object, beaten up, choked, burned, or threatened or harmed with a knife or gun). One third of the women experienced major violence during the year before they were interviewed. Greater severity of homelessness, engaging in subsistence activities, and victimization during childhood were significant predictors of major violence. Analyses suggested that drug dependence might influence victimization risk through sex trade. Major violence against homeless women requires attention from multiple service sectors.
Article
Some ethnic minority groups in the U.K. have worked on mental health issues within their communities, but there has been little research of how the Japanese community regards these issues. However, it has been shown recently that there are Japanese people in the U.K. who are suffering from living in another culture, and the need to establish systems and facilities to deal with mental health issues for the Japanese community has been identified. It is important to explore how we can develop the services in a culturally appropriate way. In the U.K., counselling and psychotherapy are largely based on Western psychology and cross-cultural issues focus mainly on Black/White relationships, and some issues are not applicable to Japanese clients. This article explains the current stream of cross-cultural issues in the U.K. and some aspects of Japanese culture. It goes on to summarise research results and address the need for professional services, highlighting possible obstacles and problems, as well as the areas where more work is required.
A review of research reveals that the prevalence rates of depression, somatization, and posttraumatic stress disorder among Asian Americans are at least as high as those for White Americans, and, in many cases, higher rates are exhibited. Findings with respect to anxiety have been equivocal. The conclusion that is best supported by research at this time is that Asian Americans are not extraordinarily well adjusted, in contrast to their stereotype as a model ethnic minority group. What has hindered researchers in determining the rates and distributions of mental disorders among Asian Americans has been methodological and conceptual problems. These problems involve (a) making cross-cultural comparisons using assessment instruments that have been standardized on one group and applied to another and (b) phenomena unique to Asian Americans, including their population size, heterogeneity, and rapid demographic changes. Suggestions for research directions are given.
Article
This exploratory study conducted from 1997 to 1998 is the first study to empirically investigate Greek battered women's help-seeking behavior from informal sources of help. In-depth interviews were conducted with 17 abused women in the only refuge for battered women in Athens. Results of this study indicate that Greek women tend to suffer years of violence before they ask for help because of various personal and sociocultural factors. These factors center around feelings of shame and guilt, hope that things will get better, and the concepts of marriage and the family that are of central importance to women's lives in Greece. The article concludes by highlighting the importance of using systems of informal support and recommending the need for more research on the issue of violence in Greece.
Article
Researchers have given some attention to women law enforcement officers' experiences and perceptions of sexual harassment. Yet, few studies have determined how the interaction of gender and race affect African American women's perception of this workplace impediment. This article explores one group of women's experiences in a U.S. sheriff's department. Interview data gathered from 65 African American women who are active and former law enforcement officers provide a comprehensive examination of how African American women in nontraditional criminal justice occupations experience racialized sexual harassment. Differences in degree and frequency of harassment are found among the women in different cohorts based on their job tenure, marital status, and the race of their harassers.
Article
This article examines factors related to husbands' contribution to housework when their wives become newly impaired. Data are from a sample of 319 married couples who participated in the National Survey of Families and Households, and in which wives developed physical limitations between baseline and five-year follow-up interviews. Using ordinary least squares regression, we found that husbands who have egalitarian attitudes toward marital roles and are happy in their marriage at baseline do more housework at follow-up than husbands who are traditional and/or are less happy. Given the slow rate of change in household division of labor, the lack of public policies to support people with impairment and family caregiving disproportionately burdens women.
Article
MMPI-2 studies have emphasized the importance of establishing validity indices for the evaluation of over reporting and malingering. In this study, 42 chronic outpatients are administered the MMPI-2 under honest and feigning conditions. Results indicated that patients under honest conditions have elevated scores on F, Fb, and other validity scales. Therefore, stringent cutting scores are recommended to minimize the misclassification of bona fide patients as malingerers. Toward this end, F > 29 produced a highly accurate classification rate, whether subjects with high VRIN scores were excluded. In addition, the newly derived Fp scale appeared promising for subjects with low VRIN scores and deserves further investigation.
Article
The current study examined the effects of validity-scale coaching on one's ability to feign general psychopathology. College students were coached on malingering strategies and completed the MMPI-2. Their responses were compared with students asked to malinger psychopathology without validity-scale coaching and with psychiatric inpatients completing the MMPI-2 under standard instructions. In accordance with previous research (e.g., J. R. Graham, D. Watts, and R. E. Timbrook, 1991), uncoached malingerers were adequately discriminated from patients by using the Infrequency (F) scale. However, as suggested by previous research (R. Rogers, R. A. Bagby, and D. Chakraborty, 1993), the F scale was not as effective at classifying coached malingerers. It was found that other validity indicators, such as the Infrequency Psychopathology Scale were more accurate at discriminating between coached malingerers and hospitalized patients. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The purpose of this investigation was to examine the performance of federal minimum security inmates given experimental instructions to malinger psychopathology on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; J.N. Butcher, W.G. Dahlstrom, J.R. Graham, A. Tellegen, & B. Kaemmer, 1989) and to compare the results from these experimental malingerers to those from samples of inmates and psychiatric inpatients given the test under standard instructions. Results indicated that the MMPI-2 validity scales can differentiate with a high degree of accuracy inmates instructed to malinger mental illness from actual psychiatric patients. This study is one of few applications of the new Back Side F (Fb) scale. It was found to be less accurate in classifying experimental malingerers than the Infrequency (F) scale.
Article
Patients suffering from chronic PTSD were recruited into a study in which they had to monitor and record in a diary their intrusive systems on a daily basis for 4 weeks. Assessments were carried out before and after monitoring. Seventeen patients dropped out of the study during the monitoring period, 12 patients no longer met criterion for PTSD, and 72 were still cases at the second assessment. A comparison of improvers, cases, and dropouts indicated that improvers scored significantly lower on all assessment measures prior to monitoring, and were more likely to be employed than the other two groups. Improvements made over the monitoring period were discussed.
Article
Proposals are set out for the introduction of psychological analyses into the conventional study of comorbidity. It is suggested that in addition to the simple determination of the co-occurrence of two disorders, attention should be given to the psychological connectedness of the two disorders. Such connectedness can be assessed by: (a) behavioral analysis of the functional interdependence of the disorders, (b) assessing the person's subjective estimate of the degree to which the disorders are connected, (c) similarities in psychophysiological responsiveness to eliciting stimuli, and (d) semantic similarities. Examples from research on the connectedness of two or more fears are described, and the lack of correlation between subjective similarity and functional relatedness is noted. It is suggested that introduction of psychological analyses will serve to expand our grasp of the disorders concerned, flag possible complications, provide a better basis for prognoses, and help to improve treatment efficacy.
Article
An extensive body of literature has documented the widespread and damaging nature of sexual harassment among Anglo women, but little attention has focused on the experiences of women of color. The current paper begins to address this gap by comparing sexual harassment incidence rates and psychological and work-related outcomes of Hispanic and non-Hispanic White women across varying levels of cultural affiliation. Chi-square tests of association suggest that risk of harassment increases with affiliation to the mainstream U.S. culture, and hierarchical regression analyses suggest that cultural affiliation moderates the relation between sexual harassment and occupational functioning. These provocative findings are discussed in the context of social and economic vulnerability, socio-sexual norms, and cultural background.
Article
The authors used a sample of federal district court opinions between 1980 and 1999 to examine how judges, plaintiffs, and defendants responded to the Supreme Court's 1993 Daubert v. Merrell Dow Pharmaceuticals, Inc. decision. They found that after Daubert (a) judges were more likely to evaluate the reliability of expert evidence, (b) the standards for admitting expert evidence tightened, and (c) the parties proposing and challenging evidence responded to the change in standards. The authors also examined how "general acceptance" of proposed evidence in the specific expert community enters the reliability assessment and which types of evidence were most affected by Daubert. Even though judges are more actively screening expert evidence, whether they are doing so in ways that produce better outcomes has not been determined. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Recently, a new infrequent response indicator, Frequency psychopathology, F(p), was developed for the Minnesota Multiphasic Personality Inventory—2 (P. Arbisi & Y. Ben-Porath, 1995). F(p) has potential to provide users with a better understanding of elevations on Frequency (F) and F-back ( FB) in settings where such elevations are commonly observed because it is less influenced by the confounding effects of distress and psychopathology. The study reports F, FB, and F(p) scale characteristics from 308 male psychiatric inpatients by Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.) diagnosis. The mean F(p) scale score uniformly fell considerably below scores on F and FB and was independent of diagnosis. These findings provide further support for the use of F(p) as a sensitive index of profile invalidity in psychiatric populations. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Two groups of normal adults were given specific symptom information on posttraumatic stress disorder (PTSD) and paranoid schizophrenia, respectively, and instructed to simulate these disorders on the MMPI-2. Monetary prizes were offered for successful faking. To determine whether symptom information helped Ss produce responses that closely resembled patients' profiles, scores from fakers were compared with scores from patients with these disorders, using a 2 × 2 (Disorder × Response Style) ANOVA. Results showed significant differences for response style, with fakers in both groups producing lower scores on K and higher scores on F, Fb, F–K, Ds, as well as on all 10 clinical scales, than patients. The findings suggest that having specific information about the symptoms of psychological disorder does not enable fakers to avoid detection and/or produce profiles equivalent to those produced by patients with the disorder. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Evaluated whether veterans who apparently exaggerate their symptoms are more likely to be (a) seeking disability compensation or (b) suffering from more comorbid pathology than nonexaggerating veterans. 54 of 145 (37%) veterans with posttraumatic stress disorder who completed the Minnesota Multiphasic Personality Inventory—2 (J. N. Butcher, W. G. Dalhstrom, J. R. Graham, A. Telegen, & B. Kaemmer, 1989) were identified as apparent exaggerators, with F (Frequency)– K (Correction) >13. These participants scored higher than nonexaggerators on self-report measures of various psychological symptoms but were no more likely to be seeking compensation or to have comorbid substance use or other anxiety disorders. Affective disorder was overrepresented among apparent exaggerators, however. Findings support the hypothesis of increased comorbidity among symptom exaggerators as measured by the F–K index but not the commonly held belief that symptom exaggerators are more likely to seek compensation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Because of the dramatic increase in the ethnic diversity of Americans and the shrinking world in which international contacts are commonplace, our society is confronted by problems and issues associated with race/ethnic relations. In the fields of community psychology and community mental health, ethnic diversity has posed challenges and opportunities, as well as problems. How can we better understand the cultural, experiential, and psychological sense of different ethnic communities? What means can be found to facilitate ethnic and racial harmony? What kinds of prevention and intervention strategies can be used to promote the well-being, growth, and development of individuals from diverse ethnic groups?
Describes posttraumatic stress disorder (PTSD) and head injury within the context of personal injury lawsuits. It is concluded that an injury that is accompanied by concussion cannot be followed by a PTSD. The hallmark of PTSD is preoccupation with the trauma. If individuals have no memory of the events preceeding their injury, they can neither ruminate over them nor have flashbacks of them. Patients with PTSD are reluctant to discuss their trauma, show emotional agitation or withdrawal from it, and are constantly bothered by flashbacks of traumatic event(s). In contrast, victims of head injury have no difficulty discussing what they remember of their injury, show no emotional upset when talking about it, and are not troubled by flashbacks. If individuals involved in an automobile accident, suffer a concussion, are unable to remember the accident, and then claim a PTSD, the diagnosis of postconcussion syndrome or malingering should be considered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The ability of persons faking posttraumatic stress disorder (PTSD) or closed-head injury (CHI) to respond consistently across serial testings on the Minnesota Multiphasic Personality Inventory—2 (MMPI-2; J. Butcher, W. Dahlstrom, J. Graham, A. Tellegen, & B. Kaemmer, 1989) was investigated. Results showed that individuals faking PTSD obtained 2-week test–retest reliability scores comparable to individuals completing the MMPI-2 with standard instructions; individuals faking CHI obtained reliability coefficients significantly lower than individuals faking PTSD. A 3 × 2 (Response Style × Time) analysis of variance indicated that individuals faking a disorder obtained significantly elevated scores on validity scales sensitive to overreporting; no main effect for time was found. Results suggest that test-takers faking specific disorders can describe symptoms consistently on repeated testing and that type of disorder may affect temporal response consistency. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Explored the effects of both random responding and malingering on the validity scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in an analog design using 4 groups of college students. One group completed the entire answer sheet randomly, a 2nd group was instructed to malinger a moderate psychological disturbance, a 3rd group was asked to simulate a severe disturbance, and a 4th group was given standard test instructions. Results showed that MMPI-2 validity scales were sensitive to these response sets: Both random and malingered responses produced significant elevations on F and Fb, whereas only random responding led to significant elevations on VRIN. These results indicated that the source of an elevated F scale may be clarified by referring to VRIN, as VRIN was significantly elevated only in the random response group. Thus, a high F scale score combined with a high VRIN scale score strongly suggests the possibility of random responding. In addition, scores on both F–K and Ds2 (the items remaining from the MMPI Dissimulation scale) increased significantly as degree of simulated disturbance increased. Thus, Ds2 appeared to have sufficient promise as a validity scale to merit further research. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Discusses emerging issues in the study of the effects of disaster on children, noting that research has established that both adults and children use denial as an initial method of coping with a major disaster. Parental reactions to disaster are important to the sense of psychological well-being experienced by children: If parents exhibit symptoms, the symptomatology is transferred to the child and expressed in similar fashion. In the absence of parents, the importance of significant human caring relationships subsequent to disaster is fundamental to the child's ability to cope with trauma. Immediately observable effects of disaster in children include fear of death, separation, and further trauma; misidentification of perpetrators and/or hallucinations; absent vegetative nervous effects; monotonous, compulsive play; chronic anxiety; and somatic disturbances. Researchers to date suggest that further studies of children's reactions to trauma include a standardized disaster questionnaire, a standardized mental status examination, a child history with educational and IQ data, established child behavioral and anxiety scales, and psychiatric diagnoses. A format for an interview with a disaster-stressed child is recommended. Common problems that clinicians may experience in studying or treating disaster-stressed children are also noted. (13 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Points out that diagnosing psychological disorders requires not only an organizational framework, but also a method of gathering information about a patient or client. The author reviews the literature on diagnosis and demonstrates that, although structured or semi-structured interviews increase interrater reliability, reliance on a single source (whether patient, clinician, or other) often results in diagnoses that are unstable and inaccurate. Consequently, he recommends gathering information from multiple sources, no matter what diagnostic system is used. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This article describes sexual abuse as well as several other dimensions of victimization, such as institutional racism, that American ethnic minority children are likely to encounter. Some of these other forms of victimization parallel the dynamics of child sexual abuse and posttraumatic stress disorder. The Four Traumagenic Dynamics model, which examines the dynamics of the effects of child sexual abuse, is applied to the experiences of ethnic minority children. The importance of assessing a variety of victimization experiences in this population is discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The psychosocial effects of the 1989 Newcastle earthquake on 250 immigrants from non-English-speaking backgrounds (NESB) were compared with a matched sample of 250 Australian-born subjects. The NESB subjects had higher levels of both general (General Health Questionnaire-12) and event-related (Impact of Event Scale) psychological morbidity. Furthermore, NESB females had the highest levels of distress, particularly those who were older on arrival in Australia and those who experienced high levels of disruption. The results suggest that NESB immigrants, particularly women, appear to be more at risk for developing psychological distress following a natural disaster. However, level of exposure and an avoidance coping style contributed more substantially to psychological distress than ethnicity. (C) Williams & Wilkins 1995. All Rights Reserved.
Article
The anxiety disorders reflect an underlying hierarchic organization. They all share a common higher order dimension of neuroticism/negative affect, which represents a general vulnerability to stress. In addition, each individual syndrome contains a unique component (which itself may reflect multiple lower order dimensions) that distinguishes it from all of the others. Recent evidence relevant to dimensions at varying levels within this hierarchy is reviewed. Curr Opin Psychiatry 12:181-186 (C) 1999 Lippincott Williams & Wilkins.
Article
Eye Movement Desensitization and Reprocessing is a new and controversial cognitive–behavioural treatment technique that combines cognitive processing and exposure methodology to treat conditioned emotional responding and other trauma-related symptoms. EMDR is controversial in part due to initial excessive claims by its originator, Francine Shapiro, and also because of what many believe to be Shapiro's proprietary emphasis in controlling who may use the technique with patients. In this paper our aim is to take an objective look at the process and effectiveness of this technique. The purpose here is to (1) offer a brief objective review of the outcome literature to date on EMDR; (2) present a short summary of results of an ‘early look’ at an ongoing controlled study of this method that we are presently conducting; (3) speculate on the merits of this approach based on both scientific and clinical experience with EMDR and (4) offer a brief description of the evolved process of EMDR along with a commentary on that process.
Article
ABSTRACT The present paper will review and discuss researchissues and findings of recent corss-cultural studies of severe mental disorders. The paper is divided into two main sections. The first section will discuss: (1) the concept of culture, (2) hierarchical levels of human behavior determinants, (3) the cultural variability continuum, and (4) the concept of self. The second section will discuss: (1) epidemiology, (2) culture and clinical phenomenology in severe disorders, and (3) culture as an etiological determinant. The paper closes with a discussion of some conclusions and suggestions for future research.
Article
This study examines psychometric properties of the Civilian Mississippi Scale for posttraumatic stress disorder when administered in a community survey of 656 persons following the 1989 Loma Prieta earthquake. Internal consistency was lower (Cronbach's α = .73) than for previous analyses of civilian and combat versions of the Mississippi Scale. The analysis produced one strong factor composed of 25 items with regular wording and a second, weaker factor composed of 10 items with reversed wording. Internal consistency was higher when the 10 reversed items were removed (Cronbach's α = .86); the two factors were negatively correlated. Traumatic experiences and psychological distress measures explained more variance in the 25-item factor than in the 35-item scale. Further studies should focus on content analysis and performance of the reversed items.
Article
The focus of this research was on faculty members as victims of sexual harassment by colleagues (peer harassment) and students (contrapower harassment). A self-administered, mailed questionnaire was sent to a probability sample of faculty at a large, public Midwestern university and to the whole population of faculty at a small, public institution in the Western Mountain region. Several hypotheses were made based on conflict theory, role theory, and previous research. Results indicated that women faculty generally have more negative attitudes toward and broader definitions of sexual harassment than do male faculty. Moderate levels of sexual harassment of faculty by both colleagues and students were reported; minor and anonymous (course evaluations and obscene phone calls) forms were the most common. Female faculty were more likely to report harassment by colleagues; male faculty were more likely to report some potentially harassing behaviors by students. Incidents of sexual harassment were usually not reported to formal agents of social control.
Article
A community sample of 355 adult women were administered the Symptom Checklist-90-Revised and were assessed with structured interviews for a life-time history of criminal victimization and Crime-Related Post-Traumatic Stress Disorder. Using a criterion group classification approach, a 28-item scale within the SCL-90-R was developed that successfully discriminated between the CR-PTSD positive and negative respondents. Though replication and further research is needed, the developed scale may be of use for initial screening for CR-PTSD as well as for ongoing clinical assessment and research purposes.
Article
This study investigated the association of several dimensions of relationship to perpetrator of childhood sexual abuse to posttraumatic symptomatology in adulthood. A structured clinical interview, the Impact of Event Scale, and the TSC-40 were administered to 67 women survivors seeking psychotherapy. The t-tests for significant differences indicated that subjects whose perpetrators were not caretakers experienced higher levels of posttraumatic symptomatology (PTS) in adulthood than those abused by caretakers. No significant differences were found in traumatic symptomatology between those whose perpetrators were family members and those whose perpetrators were not or between those abused by someone in the home and those abused by someone outside the household. Implications for future research and clinical practice are explored.
Article
We conducted two studies to shed light on contrapower sexual harassment in an academic setting. In the first study, we surveyed a random sample of 158 college students (83.4% White) concerning their potentially sexually harassing behaviors toward professors, sexist attitudes toward women, and proclivities to harass sexually. Almost one third of the students reported having sexually harassed a professor at least once. Male students were more likely than female students to be the perpetrators. In the second study, all tenured and tenure-track faculty were mailed a survey; 209 professors (88.9% White) completed the survey concerning their experiences with sexual harassment from students as well as their coping responses, definitions of sexual harassment, and reactions to hypothetical scenarios. Over one half of the professors reported having been at least once sexually harassed by students. Although male and female professors experienced similar rates of sexual harassment from students, the psychological outcome was worse for women than for men. Male and female professors defined sexual harassment similarly. However, when more contextual information was provided in the hypothetical scenarios, several gender differences emerged. In addition, men and women used both internal and external coping responses to different types of sexual harassment. Sexual harassment as both a tool and a result of male dominance in society is discussed.
Article
Vietnam Veterans with severe post-traumatic stress disorder often report the following combat experiences: a leader''s betrayal of what''s right, lost responsiveness to claims outside a tiny circle of combat-proven comrades, grief and guilt for a dead special comrade, lust for revenge, renunciation of homecoming, feeling already dead, going berserk, dishonoring the enemy, and atrocities. These elements are all in Homer''sIliad account of Achilles, allowing the reader to witness them as they happen, so to speak. Homer''s view of healing and regained humanity is discussed in relation to theIliad''s final scene. TheIliad offers a cross-cultural look at men in battle, and raises questions about some assumptions in American military culture, particularly regarding grief and the need to degrade the enemy to make men fight. Betrayal of what''s right and the berserk state are suggested as key pathogens for PTSD in combat soldiers.
Article
Deficiencies in basic trust frequently undermine the efficacy of group therapy in multiracial and multicultural groups. It is necessary to distinguish trust deficits caused by individual psychopathology, societal attitudes (cultural pathology), or a combination of both. A typology for classifying self-disclosure problems in multicultural and multiracial groups is presented, and illustrated with case material: Mode A, Good enough trust, allows patient self-disclosure in multicultural groups; Mode B, Low level of cultural paranoia and high level of functional paranoia; Mode C, Culturally paranoid individual can self-disclose in culturally homogeneous group but mistrusts outsiders; Mode D, Confluent paranoid has high levels of both functional and cultural paranoia. For Modes C and D, it is crucial that experiences of bias be acknowledged and empathized with first before patients will be able to achieve good enough trust to risk self-disclosure. The ethnic composition of the group must be attended to in the placement of these patients. Hospital (inpatient) groups are especially likely to have problems with basic trust. The role of the leader in demonstrating empathy, tolerance, racial sensitivity, and appropriate self-disclosure is emphasized. Cultural awareness training, a personal group therapy experience for the therapist, and the use of co-therapists are recommended as ways of minimizing negative countertransference or cultural bias on the part of the leader.